Keep calm and sleep better with the baby!

In the first few weeks of life, the newborn’s central nervous system is still immature and disorganized. His sleep-wake cycles are random, and he is likely to sleep 16 to 18 hours a day in three- to four-hour cycles, waking three or four times during the night, and needing your help to go back to sleep. By about three months, as his brain matures and he is becoming “entrained” to the routines around him, he is consolidating his sleep, sleeping through two six-hour sleep cycles at night, and taking one or two long daytime naps. You can reassure yourself that by one year most babies sleep 10 to 12 hours at night and can go back to sleep on their own if they do wake.

But just as there are adult “larks” who rise with the dawn and “owls” who are ready to party at 11 PM, infants also vary in their natural body clocks. Research published in Child Development shows correlations among the regulatory processes of sleeping, eating, and crying in infants. Some babies are described as “fussy,” showing more reactivity to stimuli of all kinds, and these babies are most likely to experience sleep disruptions and to have trouble getting themselves back to sleep without help.

When Difficult Becomes Problematic

Most parents of infants will experience sleep deprivation in their child’s first year of life, particularly with night waking and difficulty returning to sleep. And most infants become “discombobulated” on occasion when Grandma comes to visit or the family is traveling. But when does sleep deprivation become a “sleep problem?”

Medical experts have been unable to reach consensus about when sleep becomes a medical issue. Your doctor may focus on how often your baby wakes during the night, how long she stays awake, and whether you have to take her to your bed just to get some sleep. Has the occasional night spent in the rocking chair turned into your regular routine? Perhaps more important are the consequences of the sleep problems. Is either parent having difficulty performing daily tasks at work or home due to sleep deprivation? Are siblings falling asleep at school because of nightly waking? Finally, are family relationships suffering due to impatience, hostility, and lack of relaxed family time?

Ruling Out Physical Problems

A number of common medical issues can cause sleep problems, such as congestion or teething, so it is wise to discuss sleep issues with your pediatrician at your child’s regularly scheduled well-child visits. These routine issues should be differentiated from chronic illnesses requiring medical attention, such as ear infections, asthma, reflux, or milk allergy.

According to Klaus Minde, author of The Sleep of Infants and Why Parents Matter, your physician also may rule out sleep apnea, a condition in which an infant awakens periodically because he stops breathing.

What You Can Do

Given that your infant is healthy, there are a number of steps that you can take on your own to help him or her sleep better. Sleep patterns result from both internal (such as circadian rhythms and hunger) and environmental cues. While your baby’s circadian rhythms are maturing, you have some control over the external cues.

According to an article published in Behavior Therapist, your baby is gradually coming to anticipate and align himself with your behavior, through a process called “entrainment.” The process includes alignment with your family’s sleep-wake cycles. The authors state that using white noise and scheduled bedtimes often reduces infant and childhood sleep disturbances.

Here’s how you can employ an entrainment process to help your child sleep better:

• Light: We become sleepy or wakeful partially in response to sunlight, so medical experts recommend that individuals who have trouble falling asleep at night get plenty of natural morning sunlight. Afternoon sunlight also may be helpful. Open the curtains in the morning, raise the blinds, or take a walk in the sun. At the same time, soften the lights in the evening to imitate the natural rhythm of sunlight. (A number of lighting companies also sell lights that dim and brighten on special timers.) Be especially careful to avoid harsh artificial light in the evenings.
• Activity: Babies who are more active during the day sleep better, so be sure your baby gets daily exercise by providing periods of physical play. Getting out of the house and exposing baby to new places and people is also stimulating. In the evening, though, reduce activity and stimulation for the last couple of hours before bedtime to allow the baby to settle down and get ready for sleep. (Ask Uncle Fred to save the “flying baby” game for the middle of the day.) Tone down the activity during night feedings, too, and speak in a hushed voice. Don’t turn on the television, which provides both stimulating noise and harsh light. My son came to expect lively conversation and stories during his nocturnal feedings until I realized that he was having too much fun to go back to sleep!
• Routine: Just as adults sleep better with regular routines, so your baby needs a predictable schedule and rituals. Predictable routines such as a bath and story not only help to form a habit so that baby knows it’s time to go to sleep, but they also enhance feelings of security. Putting your baby down to sleep means separation from you; the young infant cannot use a mental image of his parent to feel safe, so a routine helps him to bridge this gap.

If you are not co-sleeping, put your baby to bed while he is awake so that he will become accustomed to going to sleep in his crib. If you form the habit of rocking him to sleep each night, he will not be able to soothe himself back to sleep without your help when he wakes.

If your baby is not awakening because of hunger, resist the urge to use a feeding to put him back to sleep because you may create a new routine and prolong your baby’s irregular sleep schedules.

• Signals and Soothing: All infants wake up at least once during the night, and early in life they nearly always require their parents to return to sleep. As they mature, though, they must learn to soothe themselves back to sleep. You can help your baby achieve this important milestone.

First, don’t go in immediately when he cries. Many times Baby is not really awake and will settle back to sleep if given time. When you must go in, don’t pick him up immediately. Try a soothing word, rubbing his head, or patting his tummy softly. Doing the minimum needed to help your baby return to sleep will help him learn to regulate his own sleep.

Second, consider using a pacifier. In a December 2005 study published by scientists from Kaiser Permanente and the National Institutes of Health, it was found that babies who slept with pacifiers had a 90 percent reduced risk of crib death compared to babies who slept without pacifiers. “Our results also provide some evidence that use of a [pacifier] may reduce the impact of other risk factors for SIDS, especially those related to adverse sleep conditions,” adds Dr. De-Kun Li of Kaiser Permanente California, in the online report from the British Medical Journal.

In addition to these new findings, using a pacifier can be soothing for young babies as well as potentially life-saving. Also, most newer pacifiers are shaped so that they are not bad for baby’s teeth.

As your baby gets older, you can phase out a pacifier in favor of a favorite toy or blanket, known also as a “transition object,” to help her feel secure and sleep better.

When More Help is Needed

Some parents have used a technique called “behavior shaping,” a process described in Early Child Development and Care to change Baby’s behavior by gradually withdrawing parental attention as he falls to sleep. Most parents cannot tolerate the “cold turkey” approach to letting their infant cry himself back to sleep, and even the originator of that practice no longer recommends it.

For a small number of infants, sleep problems stem from the infant-parent relationship. If Baby does not feel secure and confident that his parents will be there to meet his needs, bedtime is frightening, and he has difficulty relaxing and settling to sleep. Your pediatrician can help you find an attachment therapist to help you assess whether your baby’s sleep problems stem from insecure attachment.

Sometimes a mother’s depression may contribute to a baby’s feelings of insecurity. In other cases, extreme sleep deprivation may cause depression in a new parent. Consult with your own physician if you have had significant changes in mood or appetite, feelings of hopelessness, or especially thoughts of suicide. Seek help also if you feel hostile toward your baby or feel like striking or shaking her when she does not sleep. Shaking an infant, even mildly, can cause serious injury or death.

Most parents just need to “hang in there” until their baby’s brain matures and she adapts to the family routine. So be patient—seek help when you need it—and take care of yourself.